There I was, late on a Friday night, in a hospital room, gazing blankly with my third-year medical student on-call partner at the patient who was seizing in front of us. We were the first to have noticed him, but continued to stare together dumbfounded as to what should be done. It could have been a scene from a dark comedy film; we were useless, flapping our arms with ineptitude.
Fortunately, a nurse noticed our ineffectual motions and came to the rescue. A team descended upon the patient and proceeded with a successful resuscitation necessitating intubation and a full cardiac arrest protocol followed by transfer to the medical ICU. My first witnessed arrest and resuscitation, never to be forgotten.
In addition to my appreciation for how important nurses were to the eventual success of medical students, this incident was also a moment of realization of how important multidisciplinary teams are to successful outcomes in patient care. Interestingly, my subsequent academic career followed two disciplines where inter-professional teams are paramount: trauma surgery and critical care medicine.
I eventually became president of the Society of Critical Care Medicine (SCCM), an international society that prides itself on inter-professional team-based care practices and has more than 17,000 members in more than 100 countries.
The World Health Organization (WHO) defines inter-professional care as “multiple health workers from different professional backgrounds working together with patients, families, carers (caregivers), and communities to deliver the highest quality of care.” In actuality, this recognition for the importance of organized inter-professional care is a relatively new.
Fortunately, today many medical schools are exposing students to learning environments where inter-professional team interactions are introduced and reinforced. Similarly, numerous simulation training centers in healthcare are taking advantage of their settings to provide similar exposures to inter-professional team-based clinical case scenarios.
Clinical disciplines from a variety of professions and backgrounds are now routinely involved in these types of practices. But interestingly, of the 192 U.S. medical schools, only about 10 share campuses with schools of nursing, pharmacy, dentistry, and other clinical disciplines.
So how many job types and titles exist in healthcare, not including the physician-related specialty tracks, of which there are more than 160 in the United States alone?
Indeed.com lists 50 healthcare job types, Stepful.com lists 58, Nurse.org lists more than 80 types, Mayo Clinic College lists more than 40 study opportunities, and the Bureau of Labor Statistics tabulates detailed information on 47 healthcare careers, as well as numerous others without detailed listings. According to the BLS, in 2023 there were 16 million jobs in American healthcare and approximately 2 million new healthcare job openings per year.
American healthcare is an industry that spends more than $4.7 trillion annually, representing nearly 20% of the nation’s annual gross domestic product (GDP). Our industry is huge, expensive, and complex. While the patient-physician relationship is still the dominant driver of the industry on many levels, the historical vantage point of physicians being primarily in charge no longer holds. Significant and obvious shifts continue.
EMBRACING INTER-PROFESSIONAL TEAM COLLABORATION
All physicians, whether in formal titled leadership roles or not, necessarily must recognize the importance of inter-professional care and become even more adaptable in terms of how physicians participate with inter-professional care practices — whether as physicians leading teams or simply as an important part of inter-professional teams. And approximately 20–25% of physicians are actually employed in non-clinical roles.
The importance of the patient-physician relationship, however, will continue to ensure the leadership role for all physicians, at least for the foreseeable future. But as physician leaders, we must correspondingly continue to recognize the unique privilege we hold among the constellation of all those other job types in healthcare. Respecting others in the workforce and not being perceived by others as entitled is crucial to how physician leadership is embraced moving forward.
Our association is already involved with these inter-professional trends. AAPL is a member of the National Collaborative for Improving the Clinical Learning Environment (NCICLE), a forum for organizations committed to improving educational experiences and patient outcomes. The American Interprofessional Health Collaborative and the National Center for Interprofessional Practice and Education (Nexus) are two other groups AAPL is involved with. The latter is based at the University of Minnesota, coincidentally co-founded by a fellow past-president of the Society of Critical Care Medicine, Frank Cerra, MD, MCCM.
A variety of our own AAPL initiatives, primarily with institutional customers and contracts, already have strong inter-professional engagement, with many non-physicians partaking in our leadership development programs. AAPL has participated in an assortment of other forums over the years and has strong collaborative relationships with a wide range of non-physician professional societies. AAPL has also co-produced or been involved in white papers and position statements involving other healthcare professionals’ vantage points.
The AAPL Board of Directors has been prescient with embracing these trends of inter-professional leadership education, training, and patient care practices.
Other trends worth considering in this context of inter-professional healthcare is the shift toward patient care outside the traditional settings of hospitals or physician practices. Technology trends are creating diverse opportunities, large-scale, non-healthcare businesses are entering healthcare more assertively, and expansive private equity investments in physician practices are just a few examples. Another is the expansion of education credentials and licensure criteria with various non-physician clinical disciplines.
While these trends inevitably evolve, physicians will continue to be confronted with the push/pull influences of how best to adapt and adopt inter-professional care models, as well as evolving inter-professional leadership models. Embracing the opportunity of these trends, not resisting them, is the better path forward, in my opinion.
EMBRACING COMPLEXITY
Physician leadership, however defined, remains essential and vital for the ongoing improvements and refinements necessary for the industry. Navigating the potential and leveraging the prospect is where true physician leadership can benefit the eventual outcomes for those working in the industry and for those receiving care from our industry.
Oh, and that unknown seizing patient witnessed by two inexperienced medical students? He did OK in the end. Turns out he was a functional alcoholic, unbeknownst to the medical team. He was admitted for another medical condition but then went into delirium tremens. The floor nurses, resuscitation team, and ICU team saved him and he was discharged home in good condition.
Remember, leading and creating significant positive change is our overall intent as physician leaders. AAPL focuses on maximizing the potential of physician-led, inter-professional leadership to create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally.
Therefore, as physician leaders, we must embrace the complexities of our industry and the opportunities where our individual and collective energies create the value needed desperately for our industry. A transformation toward inter-professional care practices has been inherent in the patient-physician relationship for centuries. Let us all keep maximizing the future opportunities in front of our profession.
Through this AAPL community, we all can continue seeking deeper levels of professional and personal development and recognize ways we can each generate constructive influence at all levels. As physician leaders, let us become more engaged, stay engaged, and help others become engaged. Exploring and creating the opportunities for broader levels of positive transformation in healthcare is within our reach — individually and collectively.